Unemployed Doctors? 1 In 6 New Specialists Can’t Find Work, Study Says
The numbers of both entering practice here have also increased dramatically over the past decade, and there is considerable pressure, particularly from Canadians who have gone abroad for training (currently about 3,500, with more joining every year) and organizations representing them, to increase numbers even further. It is not that the one in six implies that Canada now has an overall surplus of specialists, any more than the widespread claims of shortage in the mid-1990s meant, then, that we had an overall shortage of physicians. We had then, and we have now, an inability or unwillingness as a country to develop plans and policies designed to train and deploy physicians in a sensible manner. The reports author is correct in noting that there is no quick fix here. The Royal Colleges plan to convene a meeting early next year to discuss a nationally co-ordinated approach to health system work force planning may be a useful start. It is difficult to imagine the recommendations that might emerge from such a meeting being worse than the current uncoordinated mess. At present, policy decisions, or often the lack thereof, are failing to meet the needs of new trainees or of patients. For example, there are no national (and few provincial) mechanisms in place to channel new graduates into the specialties where they are likely to be most needed rather than into the specialties most needed by teaching hospitals or most favoured by students. And despite the fact that we live in a hyper-active era of tweets and blogs in which the new generation seems to be constantly connected, there is no structured electronic meeting place for job hunters and job seekers. New graduates are somehow failing to figure out where the jobs are (and there are, in fact, plenty of communities desperately seeking specialists). In some cases, at least, the new specialists are simply the victims of the completely predictable fallout from that earlier medical school expansion. When those ministers of health agreed to fund an approximate doubling of medical school places, what did they think would happen when those students started graduating? Was there a plan in place to ensure that the complementary resources that are required for their practices would also be funded and in place? In a word, no. For example, operating room capacity or at least working capacity, meaning an available operating suite plus the funds, supplies and complementary staff to operate it has not kept pace. To make matters worse, the capacity is not used efficiently, and some of those who control that capacity are not all that keen to share with their younger brethren. The consequences in our future many more new physicians looking for practice opportunities each year, than old physicians retiring are as predictable as what we are seeing in the Royal College findings today.
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Frechette suggested, however, that a national health systems workforce planning body would be an important start. Australia, Britain and the U.S. all have such an entity. The report pointed to a number of factors that have contributed to the oversupply of specialists. Poor stock market returns in recent years have meant that some older doctors most of whom must finance their own pension plans have delayed retirement. And there has been a realignment or rationalization of tasks in health care, with nurses and physician assistants taking on responsibilities that were once left to doctors, freeing them up to do some tasks that used to fall to specialists. That effect, which Lewis called sensible, will only accelerate as less invasive treatments are brought on line. For instance, angioplasty opening blocked cardiac arteries with balloons and stents has replaced many open heart surgeries to bypass blocked arteries. Lewis suggested the cycle of training specialists which typically takes about nine years is out of sync with the cycle of assessing future medical system requirements. “Forecasting health human resource needs more than three or four or five years out is a fool’s game, because medical science changes, health needs can change, technology can change and so on.” But Frechette said there are some low hanging fruit problems that should be relatively easy to address. For instance, her study noted there are jobs going for the asking.
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